What's happened
A long-term study shows that rigorous exercise and a healthy diet reduce the risk of multiple chronic diseases among people with prediabetes, outperforming metformin. Metformin performs no better than placebo. Authors emphasize lifestyle changes as a powerful, accessible prevention strategy.
What's behind the headline?
Key takeaways
- Lifestyle interventions have lasting effects on multimorbidity beyond diabetes prevention.
- Metformin shows no added benefit over placebo for reducing multimorbidity in this cohort.
- Real-world implementation will depend on sustained patient engagement and access to resources.
What this means
- Clinicians should emphasize long-term lifestyle changes as part of risk reduction for older adults at high risk for diabetes.
- Health systems may need to invest in programs that support diet and activity changes to curb multimorbidity costs.
Limitations to consider
- The Medicare subset represents a specific population; results may differ in younger or non-Medicare groups.
- Adherence to lifestyle changes over two decades is challenging, and real-world effectiveness may vary.
How we got here
The Diabetes Prevention Program and its follow-up studied adults at high risk of diabetes from 1996 to 2021. Participants were randomized to intensive lifestyle intervention, metformin, or placebo for three years, with 21 years of follow-up in Medicare recipients. The study tracked 15 chronic conditions to gauge multimorbidity.
Our analysis
The New York Post reports that adherent lifestyle interventions reduce multimorbidity in prediabetes patients; metformin does not outperform placebo over 21 years in DPPOS. Dr. Shirin Jaggi notes how lifestyle changes require gradual adoption. See JAMA analysis of DPP and DPPOS.
Go deeper
- What practical steps can readers take to start an effective lifestyle program?
- Does this change recommendations for people with prediabetes who are already on medication?
- How might health systems support long-term lifestyle changes to reduce multimorbidity?